=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619274131
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PINES PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2011
-----------------------------------------------------
Last Update Date | 02/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8930 TAFT ST
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024-4675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-534-9166
-----------------------------------------------------
Fax | 954-342-9736
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8930 TAFT ST
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024-4675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-534-9166
-----------------------------------------------------
Fax | 954-342-9736
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | V.P
-----------------------------------------------------
Name | RICHARD OSAIYUWU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-534-9166
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PH25281
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------